Provider Demographics
NPI:1851587141
Name:STAVARIDIS, ALLISON ANNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ANNE
Last Name:STAVARIDIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:ANNE
Other - Last Name:SHUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 5486
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5486
Mailing Address - Country:US
Mailing Address - Phone:818-550-0900
Mailing Address - Fax:303-953-8260
Practice Address - Street 1:850 S ATLANTIC BLVD
Practice Address - Street 2:STE 201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4730
Practice Address - Country:US
Practice Address - Phone:626-289-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586633163W00000X
CA078582367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse